Healthcare Provider Details

I. General information

NPI: 1891557096
Provider Name (Legal Business Name): COURTNEY JESSIE LANEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2024
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 W. CLINTON AVE BLDG A STE 116
FRESNO CA
93705
US

IV. Provider business mailing address

2550 W. CLINTON AVE BLDG A STE 116
FRESNO CA
93705
US

V. Phone/Fax

Practice location:
  • Phone: 559-264-7521
  • Fax:
Mailing address:
  • Phone: 559-264-7521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number131480
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: